Uncovering the knowledge gap: A web-based survey of healthcare providers' understanding and management of dengue fever in East Azerbaijan, Iran.

BACKGROUND: Dengue fever (DF) is increasingly recognized as one of the world's major mosquito-borne diseases and causes significant morbidity and mortality in tropical and subtropical countries. Appropriate and timely diagnosis and risk stratification for severe disease are crucial in the appropriate management of this illness. Healthcare providers (HCPs) play a key role in dengue fever diagnosis, management and prevention. The present study was conducted to determine the knowledge, attitudes and practices (KAP) among HCPs in East Azerbaijan Province, Iran. METHODS: A cross-sectional survey among 948 HCPs, using a structured questionnaire, was conducted in East Azerbaijan Province from May to July 2022. Data analysis was undertaken using descriptive methods, the Chi-square test or Fisher's exact test, and logistic regression. A P-value <0.05 was considered for statistical significance. RESULTS: Out of the 948 (68.5% female) respondents, 227 were physicians and 721 were health professionals. The knowledge level of DF was found to be largely inadequate in the present study population (80.4%). The physician vs. health professional were a significant factor in differentiating attitude scores. The mean practice score regarding DF prevention and control measures among respondents was 8.40±1.97. CONCLUSION: The findings call for urgent continuous education and training courses to increase KAP levels and increased capacity and capability for DF prevention and control. This is of outmost importance for the first point of care of DF patients.

Factors associated to patients' referral to public or private Covid-19 healthcare centers in Tabriz, Iran.

BACKGROUND: In Iran, tracking of patients and its associated data recording in private healthcare centers are poor, and thus a majority of patients suffering from Covid-19 are treated without any control on the isolation and quarantine processes. The present study aims to investigate the factors contributed to referral to private or public healthcare centers that provide Covid-19 care services. METHODS: This cross-sectional study was conducted from November 2021 to January 2022 in Tabriz, Iran. We invited a total of 258 and 202Covid-19 patients from governmental and private healthcare centers, respectively, to participate in the study by convenient sampling method. Applying a self-administered questionnaire, we collected data on the reason of referring to the healthcare centers, patient's waiting time, quality of healthcare services received by the patients, patients' level of satisfaction, accessibility, insurance coverage, perceived severity of the disease, and the level of staff compliance from health protocols. Logistic regression model was used for data analysis by using SPSS-26 software. RESULTS: Adjusted for other variables, higher socio-economic status (AOR (Adjusted Odds Ratio) = 6.64), older age (AOR = 1.02), referral of friends and family members (AOR = 1.52), shorter waiting time (AOR = 1.02) and higher satisfaction (AOR = 1.02) were contributed to referral to private centers. Better accessibility (AOR = 0.98) and wider insurance coverage (AOR = 0.99) were also contributed to referral to governmental centers. CONCLUSION: Providing more appropriate insurance coverage by private healthcare centers, and promoting their level of accessibility seems to promote patients' referral to such centers. Moreover, establishing an accurate system for recording patients' information and follow up in private centers might promote the role of private healthcare centers in managing the overload of patients on healthcare system during such epidemics.

Investigation of the Factors Related to Mortality and Length of Hospitalization among COVID-19 Patients in East Azerbaijan Hospitals, Iran.

BACKGROUND: It is of utmost importance to identify populations with an elevated risk for COVID-19 and the factors influencing its outcomes. The present study aimed to investigate factors affecting mortality and length of stay (LOS) among COVID-19 patients in the hospitals of East Azerbaijan province, Iran, during 15 months of this pandemic. STUDY DESIGN: The present study followed a retrospective cohort design. METHODS: This retrospective study was conducted using data in the integrated syndromic surveillance system (ISSS) on patients admitted to the hospitals from February 21, 2020, to April 11, 2021. The association between variables of interest and death, as well as LOS, was investigated via multiple logistic regression and multiple linear regression analyses. RESULTS: In total, 24 293 inpatients with a mean age of 54.0 ± 19.4 years were included in this study. About 15% of them lost their lives, whose mean age was 69.0 ± 14.6 years, significantly higher than the recovered ones (P < 0.001). Factors, such as above 49 years of age (P < 0.001), male gender (OR = 1.17; 95% CI: 1.08-1.26), and having chronic diseases (OR = 1.32; 95% CI: 1.22-1.42), were correlated with patient mortality. In addition, having chronic diseases (Beta = 0.06; 95% CI: 0.03-0.08) was associated with higher LOS in hospitals. CONCLUSION: In conclusion, older patients were at a higher risk of mortality and prolonged hospitalization. Furthermore, patients' underlying diseases could cause a severe form of COVID-19, which can lead to death and increase patients' LOS.

The Relationship of COVID-19 Morbidity and Mortality with the History of Influenza Vaccination.

Background: COVID-19 is currently the leading global health issue. Low- and middle-income countries (LMICs) face challenges in supplying COVID-19 vaccines. To assess an adjunctive preventive measure for COVID-19 burden, we aimed to evaluate the relationship of influenza vaccination in the previous year with outcomes of COVID-19 in affirmed cases after adjustment for relevant factors. Methods: This prospective study was conducted using the provincial registry of confirmed COVID-19 cases in East-Azerbaijan province in North-West of Iran. The main outcomes were COVID-19 mortality and hospitalization. The influenza vaccination history in 2019 was collected by phone calls. Data analysis was done by SPSS software version 16, separately for healthcare workers and the general population. The logistic regression model was applied to compare the covariates in influenza vaccinated versus unvaccinated patients. Results: From 1 March to 10 October 2020, 17,213 positive COVID-19 cases were registered, of which 916 patients were included. A total of 88 patients (9.6%) deceased due to COVID-19. Two hundred subjects (21.8%) reported receiving the influenza vaccine during the past year. Healthcare workers had a significantly higher vaccination rate than the general population (28.9% vs. 7.1%; p<0.001). After adjustment for socioeconomic and health covariates, the vaccinated cases in the general population had 84% lower odds of death (OR: 0.16; 95%CI: 0.05-0.60; p=0.017). In multivariate analysis, the influenza vaccination history in the previous year was not significantly related to the lower COVID-19 hospitalization rate. Conclusion: The flu vaccination rate was not optimal in our community. The flu vaccination can be an independent preventing factor for COVID-19 mortality in the general population. The influenza vaccine can be considered as an effective adjutant preventive countermeasure for the COVID-19 burden.

SARS-CoV-2 in domestic cats (Felis catus) in the northwest of Iran: Evidence for SARS-CoV-2 circulating between human and cats.

This study aimed to investigate the prevalence of COVID-19 in domestic cats, focusing on the disease in the northwest of Iran and then showing the natural transmission of SARS-COV-2 circulating between domestic cats and humans. After receiving ethic codes from Tehran University of Medical Sciences (IR.TUMS.VCR.REC.1399.303) and confirmed by the Center of Communicable Diseases Control (CDC) of Iran, 124 domestic cats were collected from the homes and only one hospital of Meshkin -Shahr district from northwestern Iran where SARS-CoV-2 patients were hospitalized and quarantined during 2020. Samples were prepared from fluid materials of oropharynx and nasopharynx. All samples were tested by real-time PCR (RT-PCR) using specific genes N and ORF1ab in Pasteur Institute of Iran, and then partial sequence analyses of S gene were performed. All collected cats were kept in separated cages until SARS-COV-2 infection was confirmed with the RT-PCR. RT- PCR Ct values of 123 collected cats were ≥40; thus, all of them showed negative results, but one of the collected cats with close contact with its owner, whom confirmed SARS-CoV-2 showed positive results with gene N(Ct=30) and gene ORF1ab (Ct=32). Furthermore, the positive pet cat showed respiratory and gastro-intestinal clinical manifestations, and its owner was infected with SARS-CoV-2 two weeks ago. Cats are susceptible animals to SARS-CoV-2 infection. Epidemiological evidence showed that SARS-COV-2 is able to transmit to healthy cats due to having close contact with its owner as a reverse zoonosis.

Francisella tularensis human infections in a village of northwest Iran.

BACKGROUND: Recent seroepidemiological studies have suggested that tularemia could be an endemic bacterial zoonosis in Iran. METHODS: From January 2016 to June 2018, disease cases characterized by fever, cervical lymphadenopathy and ocular involvement were reported in Youzband Village of Kaleybar County, in the East Azerbaijan Province, northwestern Iran. Diagnostic tests included Francisella tularensis serology (including tube agglutination test and ELISA), PCR, and culture. RESULTS: Among 11 examined case-patients, the tularemia tube agglutination test was positive in ten and borderline in one. PCR detected the F. tularensis ISFtu2 elements and fopA gene in one rodent and a spring water sample from the same geographic area. CONCLUSIONS: Based on the clinical manifestations of the disease suggesting an oropharyngeal form of tularemia, serology results in case patients, and F. tularensis detection in the local fauna and aquatic environment, the water supply of the village was the likely source of the tularemia outbreak. Intervention such as dredging and chlorination of the main water storage tank of the village and training of villagers and health care workers in preventive measures and treatment of the illness helped control the infection.

Estimating the incidence rate of hepatitis B and C in East Azerbaijan, Islamic Republic of Iran.

BACKGROUND: The World Health Organization (WHO) has aimed for a 30% reduction in hepatitis B (HBV) and hepatitis C (HCV) incidence by 2020. To achieve this goal, it is important to have updated information about trends in the hepatitis incidence rate. However, there is a lack of up-to-date data from East Azerbaijan province in the Islamic Republic of Iran. AIMS: This study aimed to estimate the HBV and HCV incidence rate from 2011 to 2016 in East Azerbaijan, Islamic Republic of Iran. METHODS: Hepatitis data and population data were obtained respectively from the national notifiable disease surveillance system and the national Iranian census for 2016. For quantifying the rate of changes in incidence rate from baseline, the average annual rate of reduction (AARR) was calculated. For this, the linear regression model was used for estimating the beta coefficient. SPSS V25 was used for statistical analysis. RESULTS: Over the 6-year period, 3119 hepatitis cases in East Azerbaijan province were reported, of which 94.7% were hepatitis B. The majority of the affected individuals were 25-44 years old. HBV incidence was reduced by 12.71% annually between 2011 and 2016. However, the number of HCV patients increased during 2014-2016, and HCV incidence rate increased insignificantly (ß = 0.109, P = 0.39). CONCLUSION: There is a significant downward trend of HBV in East Azerbaijan due to mass vaccination programmes. In the case of HCV, when considering the availability of effective treatment regimens in addition to education and prevention programmes, policy-makers should focus on HCV screening and diagnosis, especially in the 25-44 age group.

Impact of family ownerships, individual hygiene, and residential environments on the prevalence of pediculosis capitis among schoolchildren in urban and rural areas of northwest of Iran.

In the appraisal of head lice outbreak, in addition to socioeconomic factors and availability of health care services, environmental conditions of the households must be taken into account. However, interviewing with children or mailing questionnaires to families may not reflect the actualities. Therefore, in this study, all the inclusive factors which may be associated with head lice outbreak were thoroughly and closely investigated. The data were collected by examining students at schools and surveying patients' households. A questionnaire concerning children's personal hygienic practices, family features, and environmental conditions of the households was filled out during the close assessment of the residential area. The overall prevalence of head lice was obtained as 5.9%, and the difference was not significant within the urban (5.1%) and rural (6.1%) communities. Overall, the number of infested students was more frequent in girls (6.6%) than boys (2.8%), but the difference was not significant. The highest infestation rate was obtained in the examined students whose fathers were unemployed, farmer, and herdsman. Family income showed greater correlation with the prevalence of pediculosis capitis. A high frequency of pediculosis capitis was identified among the students who were sharing individual items with siblings. Assessment of households showed that room flooring material and keeping animals at home were highly correlated with head lice prevalence. Households should be informed that infestations happen, irrespective of socioeconomic status. However, the physical and environmental conditions of living areas and households play an important role in head lice prevention.